Question:
A 4-year-old child presents with pallor, decreased urine output, and a history of bloody diarrhoea 5 days ago. Labs show anaemia, thrombocytopenia, and elevated creatinine. Which of the following is most likely seen on a peripheral blood smear?
A 4-year-old child presents with pallor, decreased urine output, and a history of bloody diarrhoea 5 days ago. Labs show anaemia, thrombocytopenia, and elevated creatinine. Which of the following is most likely seen on a peripheral blood smear?
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Classic HUS Triad:
1. Microangiopathic Hemolytic Anemia ($\uparrow$ LDH, $\downarrow$ Haptoglobin, Schistocytes on smear)
2. Thrombocytopenia
3. Acute Kidney Injury (Oliguria, $\uparrow$ Creatinine, Hematuria/Proteinuria).
1. Microangiopathic Hemolytic Anemia ($\uparrow$ LDH, $\downarrow$ Haptoglobin, Schistocytes on smear)
2. Thrombocytopenia
3. Acute Kidney Injury (Oliguria, $\uparrow$ Creatinine, Hematuria/Proteinuria).
Updated On: Sep 3, 2026
- Spherocytes
- Schistocytes
- Heinz bodies
- Target cells
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The Correct Option is B
Solution and Explanation
Concept:
Hemolytic Uremic Syndrome (HUS) is a classic thrombotic microangiopathy characterized by the clinical triad of microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and acute kidney injury (oliguria and azotemia).
It most commonly occurs post-diarrheal in preschool-aged children following infection with Shiga toxin-producing Escherichia coli (STEC O157:H7).
Explanation:
• Circulating Shiga toxin triggers widespread endothelial cell damage within the renal glomerular capillary loops and mesenteric microvasculature.
• Damaged endothelial surfaces promote platelet adhesion and the deposition of rich fibrin-platelet meshworks (microthrombi) within small blood vessels.
• As erythrocytes travel at high velocities through these narrowed, fibrin-occluded microvascular networks, they undergo intense mechanical shearing, fragmentation, and destruction (microangiopathic hemolysis).
• On peripheral blood smear examination, these fragmented red blood cells are identified as schistocytes (helmet cells, triangular cells, and fragmented erythrocytes), which is the diagnostic hematological hallmark of MAHA.
• Concurrently, platelets are consumed within the intrarenal microthrombi, resulting in profound consumption thrombocytopenia with normal coagulation parameters (PT and aPTT are normal).
• Spherocytes are seen in hereditary spherocytosis and autoimmune hemolytic anemia; Heinz bodies indicate G6PD deficiency with oxidative injury; Target cells are characteristic of hemoglobinopathies (thalassemia).
Final Answer:
The peripheral blood smear in microangiopathic hemolytic anemia of HUS characteristically demonstrates fragmented erythrocytes known as schistocytes.
Hemolytic Uremic Syndrome (HUS) is a classic thrombotic microangiopathy characterized by the clinical triad of microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and acute kidney injury (oliguria and azotemia).
It most commonly occurs post-diarrheal in preschool-aged children following infection with Shiga toxin-producing Escherichia coli (STEC O157:H7).
Explanation:
• Circulating Shiga toxin triggers widespread endothelial cell damage within the renal glomerular capillary loops and mesenteric microvasculature.
• Damaged endothelial surfaces promote platelet adhesion and the deposition of rich fibrin-platelet meshworks (microthrombi) within small blood vessels.
• As erythrocytes travel at high velocities through these narrowed, fibrin-occluded microvascular networks, they undergo intense mechanical shearing, fragmentation, and destruction (microangiopathic hemolysis).
• On peripheral blood smear examination, these fragmented red blood cells are identified as schistocytes (helmet cells, triangular cells, and fragmented erythrocytes), which is the diagnostic hematological hallmark of MAHA.
• Concurrently, platelets are consumed within the intrarenal microthrombi, resulting in profound consumption thrombocytopenia with normal coagulation parameters (PT and aPTT are normal).
• Spherocytes are seen in hereditary spherocytosis and autoimmune hemolytic anemia; Heinz bodies indicate G6PD deficiency with oxidative injury; Target cells are characteristic of hemoglobinopathies (thalassemia).
Final Answer:
The peripheral blood smear in microangiopathic hemolytic anemia of HUS characteristically demonstrates fragmented erythrocytes known as schistocytes.
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